PM Ayushman Bharat medical insurance cover may get double from Rs 5 lakh to Rs 10 lakh: Check latest update

The Parliamentary Standing Committee on Health and Family Welfare has recommended increasing the insurance cover under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY) from Rs 5 lakh to Rs 10 lakh, stating that the current limit is insufficient to cover the cost of several advanced and life-saving medical procedures.

In its 172nd Report, the committee said treatments such as liver transplants, complex cardiac surgeries and immunotherapy often cost far more than the existing coverage ceiling, leaving beneficiaries to bear significant out-of-pocket expenses despite being covered under the scheme.

The panel recommended introducing a differential treatment cost model for high-cost and complex procedures to better align PM-JAY coverage with current healthcare costs.

Why the panel wants higher PM-JAY insurance cover

According to the committee, rising healthcare costs and advances in medical treatment have made the existing Rs 5 lakh annual insurance cover inadequate for many beneficiaries.

It reiterated its recommendation to raise the coverage limit to Rs 10 lakh and create dedicated high-cost treatment packages under PM-JAY. The report suggested funding these packages through pooled financing, negotiated pricing with hospitals and manufacturers, and co-funding arrangements with state governments.

The committee said the proposed changes would help ensure that patients requiring expensive life-saving treatments are not excluded because of financial constraints while maintaining the scheme's fiscal sustainability.

PM-JAY scheme coverage and latest figures

Ayushman Bharat-PM-JAY currently provides cashless health insurance coverage of up to Rs 5 lakh per family every year for secondary and tertiary healthcare services.

The scheme has been implemented across 35 states and Union Territories. As of January 31, 2026, it had authorised 11.46 crore hospital admissions worth Rs 1.69 lakh crore, while more than 43 crore Ayushman Cards had been issued.

Panel recommends faster treatment approvals

The committee also called for stricter implementation of the prescribed six-hour turnaround time for approving cashless treatment requests under PM-JAY.

It recommended introducing penalty provisions for hospitals or agencies responsible for unnecessary delays, conducting periodic audits of the pre-authorisation process, expanding auto-approval for more low-risk procedures and deploying AI-enabled case tracking to accelerate approvals.

Focus on Ayushman Card enrolment and hospital participation

The report urged the government to intensify enrolment drives to achieve 100 per cent Ayushman Card saturation, particularly in regions with poor internet connectivity.

It also recommended addressing reimbursement concerns raised by private hospitals to encourage greater participation in the scheme.